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12U Registration Form

Thank you for your interest in Marble City Water Polo, please fill out the form below to register today!

Birthdate
Month
Day
Year
Address
Current Grade
Sex
M
F
Athlete Shirt Size
How did you hear about us?
Relationship to Athlete
Does the athlete have any allergies that we should be aware of?
Yes
No
Does the athlete have any medical conditions that we should be aware of?
Yes
No

If you wish to provide Marble City Water Polo with the athlete's medical insurance information, please upload an image of the insurance card.

MCWP EVENT LIABILITY REALEASE FORM

In exchange for the opportunity to participate in any and all Marble City Water Polo (MCWP) events, I agree to the following:

1. Waiver of Liability

I hereby waive any and all of my rights and rights of my beneficiaries to any claim(s) against MCWP, its officers, members, and/or persons acting in concert with MCWP arising from my participation in any MCWP activity.

2. Assumption of Risk

I understand that participation in sports and specifically water polo can be dangerous and may result in the accidental or other physical injury and that property damage and serious injury can occur. I knowingly assume these risks, agree to hold harmless, and to indemnify MCWP from either me or any third party as a result of such participation in any event involving MCWP.

3. Fitness to participate

I represent that I am in good physical condition, and that I have sufficient skill and experience to safely compete in any water polo event in which I choose to participate.

4. Severability

If any provision of this document is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this document had been executed with the invalid provision eliminated.

I HAVE READ THIS AGREEMENT AND I AGREE TO ALL OF ITS TERMS WITHOUT EXCEPTION. FURTHER, I DECLARE THAT I AM OF LEGAL AGE AND I AM LEGALLY COMPETENT AND FULLY CAPABLE OF ENTERING INTO THIS CONTRACT.  IF I AM UNDER THE AGE OF 18, MY PARENT OR GUARDIAN HAS SIGNED THIS FORM BELOW.

HOLD HARMLESS AGREEMENT

I understand the hazards of the novel coronavirus ("COVID-19") and am familiar with the Centers for Disease Control and Prevention ("CDC") guidelines regarding COVID-19.  I acknowledge and understand that the circumstances regarding COVID-19 are changing from day to day and that, accordingly, the CDC guidelines are regularly modified and updated and I accept full responsibility for familiarizing myself with the most recent updates.

Notwithstanding the risks associated with COVID-19, which I readily acknowledge, I hereby willingly choose to participate in Activities.

I acknowledge and fully assume the risk of illness or death related to COVID-19 arising from my being on the premises and participating in the Activities and hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE (on behalf of myself and any minor children for whom I have the capacity contract) Marble City Water Polo ("MCWP"), their officers, directors, coaches, and volunteers and assigns (the "RELEASEES") from any liability related to COVID-19 which might occur as a result of my being on the premises and participating in the Activities.

I shall indemnify, defend and hold harmless the RELEASEES from and against any and all claims, demands, suits, judgements, losses or expenses of any nature whatsoever (including, without limitation, attorneys' fees, costs and disbursements, whether of in-house or outside counsel and whether or not an action is brought, on appeal or otherwise), arising from or out of, or relating to, directly, or indirectly, the infection of COVID-19 or any other illness or injury.

It is my express intent that this Waiver and Hold Harmless Agreement shall bind any assigns and representatives, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the above-named RELEASEES.  This Agreement and the provisions contained. herein shall be construed, interpreted and controlled according to the laws of the State of TENNESSEE.  I HEREBY KNOWINGLY AND VOLUNTARILY WAIVE ANY RIGHT TO A JURY TRIAL OR ANY DISPUTE ARISING IN CONNECTION WITH THIS AGREEMENT.  I ACKNOWLEDGE THAT THIS WAIVER WAS EXPRESSLY NEGOTIATED AND IS A MATERIAL INDUCEMENT THE PERMISSION GRANTED BY RELEASEES TO BE ON PREMISES AND PARTICIPATE IN THE ACTIVITIES.

BY AGREEING TO THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it, and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Agreement for full, adequate and complete consideration fully intending to be bound the same.

CONCUSSION AWARENESS

A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.

As a Parent, and as an Athlete, it is important to recognize the signs, symptoms, and behaviors of concussions. By signing this form you are stating that you understand the importance of recognizing and responding to the signs, symptoms and behaviors of a concussion or head injury.

By selecting "I Agree", you also agree to the following:

1. I agree that my child must be removed from practice/play if a concussion is suspected.

2. I understand that it is my responsibility to seek medical treatment if a suspected concussion is reported to me.

3. I understand that my child cannot return to practice/play until providing written clearance from an appropriate health care provider to his/her coach.

4. I understand the possible consequences of my child returning to practice/play too soon

MEDIA RELEASE

The Marble City Water Polo Club has my permission to use my or my child's photograph publicly to promote the water polo club. Photos taken at polo practice, games or other team events may be used on the team's social media accounts (Facebook, Instagram, etc.) I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

​​MARBLE CITY WATER POLO CODE OF CONDUCT - ATHLETE AND PARENT AGREEMENT REQUIRED

Participating as a member of Marble City Water Polo is a privilege. As with all privileges, this entails certain responsibilities. These responsibilities are for the individual athlete, the athlete’s parent(s)/guardian(s), and the team in general. We represent water polo, and we want people who see the sport to form a positive impression of the sport at both the individual and team level. Appropriate actions will be taken to address violations of this code.​

ATHLETE

  1. Always arrive at least 5 minutes early to practices and games. For practices, athletes are expected to help with pool setup. For games, athletes must be present for warm ups. The sooner athletes are at the pool, the sooner they can focus on water polo.

  2. Treat all members of the coaching staff and referees with respect. If someone is talking, athletes shall listen and respond accordingly. 

  3. Respect all players in and out of water no matter which team they are on. There is no tolerance for bullying or harassment in any form.

  4. All athletes will put forth a good effort in all team events. The best way to improve is to show up consistently and work hard

  5. Be a good teammate. All athletes shall work to help each other improve. Athletes shall not be disruptive during games or practices. Any athletes who get in the way of the overall improvement of the team may be removed from practice. 

  6. Always fill out your Heja attendance as early as possible! This allows practices to be planned for the correct number of athletes. If you mark that you will be at practice or a game, then show up for the event!

  7. Commit to attending practice as much as possible. The best way for the team to improve is by having people to practice with. Make this sport a priority.​​

PARENT

  1. Ensure your athlete arrives on time to all events.

  2. While watching your athlete play, please keep an appropriate attitude. We would like to continue being invited to play at different pools, so please stay composed during games.

  3. Communicate with the coach about any questions or concerns you may have. Make sure the coach is aware of any situations that may take your child out of practice or an event.

  4. Provide an encouraging environment. This sport is very rewarding, but it does take some time to adjust to. Keep a positive attitude and encourage your child to keep improving.

I recognize that success is measured by more than the scoreboard. I will work to achieve success by improving and performing to the best of my abilities within the team framework. 

By signing this form, you agree to all of its terms and commit to being a member of Marble City Water Polo. You understand the expectations and will work to uphold them. Failure to do so will result in intervention by the coaching staff.

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12U Summer Registration
$85

Marble City Water Polo

©2026 by Marble City Water Polo

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